Possible Number of Recommended Sessions and Influential Factors of Hematoporphyrin Monomethyl Ether Photodynamic Therapy for Pulsed Dye Laser-Resistant Facial Port-Wine Stain.

OBJECTIVES

Some patients with port-wine stain (PWS) who have undergone several sessions of pulsed dye laser (PDL) treatment desire further improvement through hematoporphyrin monomethyl ether (HMME) photodynamic therapy (PDT). We attempted to analyse a possible number of recommended sessions and factors influencing the efficacy of multiple sessions of HMME-PDT for facial PDL-resistant PWSs.

METHODS

Forty-eight patients with facial PDL-resistant PWSs who underwent at least three HMME-PDT sessions were included in this study. All patients received an intravenous injection of HMME (5 mg/kg) followed by 532-nm light-emitting diode green light therapy. Cumulative improvement scores and single improvement scores were obtained after each session to evaluate the degree of improvement.

RESULTS

The excellent improvement rates of patients were 0% (0/48), 8.3% (4/48), 29.2% (14/48), 38.5% (10/26), and 50.0% (8/16) after 1-5 HMME-PDT sessions, respectively. A significant difference was observed in the cumulative improvement scores (p < 0.0001). Moreover, there were significant differences between any two sessions in the first four HMME-PDT sessions (p = 0.003). The improvement after the first HMME-PDT session was more obvious than that after each subsequent session (p = 0.004). A PWS less than or equal to 1% of the body surface area (OR = 9.05; 95% CI, 1.42-57.57; p = 0.020) and 5-10 sessions of previous PDL treatment (OR = 8.06; 95% CI, 2.01-32.33; p = 0.003) were positive influential factors for PDL-resistant PWS.

CONCLUSIONS

We propose that at least 4 HMME-PDT sessions could be recommended for patients with PDL-resistant PWSs, and the improvement after the first HMME-PDT session was the most evident compared with that after each subsequent treatment. Moreover, greater erythema and a greater number of previous PDL session were associated with poor HMME-PDT efficacy.